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Rates of open versus laparoscopic and partial versus radical nephrectomy for T 1a renal cell carcinoma: A population‐based evaluation
Author(s) -
Bianchi Marco,
Becker Andreas,
Abdollah Firas,
Trinh QuocDien,
Hansen Jens,
Tian Zhe,
Shariat Shahrokh F,
Perrotte Paul,
Karakiewicz Pierre I,
Sun Maxine
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12110
Subject(s) - nephrectomy , medicine , renal cell carcinoma , logistic regression , population , urology , surgery , kidney , environmental health
Objectives To examine the trends of open and laparoscopic partial nephrectomy and radical nephrectomy according to sociodemographic and tumor characteristics. Methods Using the S urveillance, E pidemiology, and E nd R esults Medicare‐linked database, 6024 patients diagnosed with T 1a renal cell carcinoma were abstracted. Multivariable logistic regression analyses were used for prediction of open radical nephrectomy, open partial nephrectomy, laparoscopic radical nephrectomy and laparoscopic partial nephrectomy. Covariates comprised of patient age, baseline comorbidity status, sex, race, marital status, socioeconomic status, population density, S urveillance, E pidemiology and E nd R esults registry, tumor size, and year of diagnosis. Results Open radical nephrectomy decreased from 89% in 1988 to 66% in 2005 ( P < 0.001), whereas open partial nephrectomy increased from 7% to 29% ( P < 0.001). Meanwhile, utilization of either laparoscopic radical nephrectomy or laparoscopic partial nephrectomy remained low. Treatment utilization differed according to S urveillance, E pidemiology, and E nd R esults registries ( P < 0.001). Increasing patient age, female sex, low socioeconomic status and unmarried status (all P ≤ 0.003) were predictors of open radical nephrectomy. The utilization rates of laparoscopic radical nephrectomy or laparoscopic partial nephrectomy varied minimally according to the examined characteristics. Older patients or women were significantly more likely to undergo laparoscopic radical nephrectomy, even after adjustment for all covariates (both P ≤ 0.02). Conclusions The rising utilization rates of radical nephrectomy are encouraging. Nevertheless, disparities of treatment type still exist. It is of concern that older and female patients are less likely to undergo nephron‐sparing surgery, and to have a radical nephrectomy by the laparoscopic approach instead.